(Inspired by “Small Kindness” by Danusha Laméris)


It’s relatively quiet on the hike-
minimal sounds of birds chirping,
lizards scurrying across the path,
footsteps against dry leaves and dirt.
The few hikers I meet have
facial expressions masked.
I can’t tell if they are smiling,
frowning, or the lips are flat-lined.
Out of nowhere comes this silent scream.
When will this all end? 
When can I see your face again?
Like a mother holding the frustrations 
of an impatient child,
I try and open to what’s here-
uncertainty, the wish for things to be different.
All I can do is thank a hiker
for stepping aside so I can pass,
wave to another hiker,
Enjoy your hike.
When I can’t see your face,
words and hand gestures 
will have to be enough.
I still miss the smiles.

It’s noontime. I’ve just finished seeing my last patient of the morning. As I head back to my workstation and pick up my phone, there are some texts from the Dasher who delivered food I ordered from Door Dash. I notice the last few texts are pictures.

There’s a white bag of food with a receipt attached standing against the backdrop of a door with a sign on it, one of the many generic gray doors that lead into buildings 1, 2, and 3 on the Fremont campus. The last text reads, “Your order was dropped off. Please refer to this photo your Dasher provided to see where it was left.”

In a blind fury, I rush outside to try and find the food, completely ignoring the picture’s details, other texts and calls explaining how the Dasher tried to reach me, where and how long he was waiting. I also suddenly develop selective amnesia for the disclaimer Door Dash gives about food being left at the door to protect Dashers from COVID exposure.

Circling the buildings like a hungry hawk ready descend on its prey, I’m not only interested in finding my food, but also the Dasher to instruct him on how to do his job. I call him and arrogantly explain my position as a busy physician seeing patients, how he should have waited, how leaving the bag where he did is completely unacceptable. He agrees to drive back to where he left the bag, and calmly suggests I take a look at the picture and instructions he left while he is on his way.

Ironically, we simultaneously arrive at the same door where he left the food. Except there is no white bag. He doesn’t know what to say. I continue to sing the same song of entitlement and how this is all a big inconvenience for me, oblivious to what he must be thinking or feeling. As he leaves, all I can think of is the lunch hour quickly being compressed into 45 minutes, 40 minutes, how I will have to drive out for food, a missed opportunity to catch up on work.

On my way back up to the office, I run into my medical assistant who tells me that a nurse saw the bag and delivered it to me. Taking a seat at my desk, I take a few bites and reflect back on the time between picking up my phone, seeing the texts and sitting here now.

In my contracted state, I conveniently forgot to slow down, to breathe, to see the larger picture. Sure I was hungry and concerned that the food I purchased was not easily accessible, but I completely dismissed the Dasher’s experience (his attempts to communicate the details of where he left the food, his unfamiliarity with the Fremont campus, possible health concerns, other orders he might be trying to fulfill).

 
****
 

Power and privilege can be dangerous when we see only what we want to see, the 10% of the iceberg that seems obvious to us, when we only hear our version of the story. We don’t realize how accepting our narrative as the only truth can cause unnecessary harm. This is where slowing down, taking a few deep breaths, getting curious, and extending compassion beyond one’s own know-it-all mind, prized body, and small heart helps to include others in the circle of awareness.
 
Power and privilege can also detrimentally impact collaboration and delivery of healthcare. False assumptions and ensuing judgments of a patient, care team member, or any employee of Sutter Health  by race, ethnicity, citizenship, religion, gender identity, sexual orientation, age, weight, socio-economic status, education level, job status, etc. to the point where is impairs their safety and wellbeing, are the damaging results of implicit bias.

How you choose to explore the 90% of the iceberg that’s submerged, the dark cold places shaped by causes and conditions of cultural upbringing, societal influence, etc., is up to you. Where do you wish to inspire meaningful change in your sphere of influence? There are plenty of ways to melt the ignorance and a solid, separate sense of self. This writing is an invitation to find out how you wish to proceed in expanding the circle of awareness.


****


Looking out the office window at the trees, I take in oxygen and release the carbon dioxide confusion I’ve been carrying for the last half hour. Then, I breath in the air of this Dasher’s reality, and breath out a compassionate apology and gratitude for the food in front of me. I pick up my phone to text him.
​
Thank you. The food found its way to me. Forgive me if I looked, sounded angry. Maybe you are new to this facility and want to limit your exposure. Please stay safe. (prayer hands emoji)
 

Bubbles and Butterflies by Shirley Reede

I was grateful for some quiet time to unplug from work - sit, walk, read, write, and engage with the Bikkhunis from Aloka Vihara and poems from the Therigatha on a home retreat for a few days.

 
Tissa ~ Third
 
Why stay here
in your little 
dungeon?
 
If you really
want to be free,
make 
every
thought--
a thought of freedom.
 
Break your chains.
Tear down the walls.
 
Then walk the world--
a free woman.
 
 
In the silence, a life pattern I’ve known about for some time resurfaced for contemplation.
 
I rely on specific outcomes, conditions for happiness.
 
Since the pandemic changed our way of life in March, I’m reflecting on identity, what really matters to me, and how I want to contribute to the wellbeing of others based on my own dance with life.
 
I was filled with ideas of healing hope, gift wrapping them faster than others could open and enjoy them. “Would any physician like peer support, mindfulness training? How about compassionate support? Would any patient like a mindfulness consultation, a tailored mindfulness meditation created just for you? Step right up and sign up for a mindfulness for stress shared medical appointment, or an online six-week meditation and reflective journaling class.”
“Take me out of respiratory clinic! That isn’t where my talent is. As every place is being hit hard economically, medicine is no exception. I’d like to make a living (right livelihood) offering mindfulness as medicine in addition to Western medicine.”
 
Just typing all this out and reading it aloud makes me realize how much energy I’ve directed into willing a certain outcome.  I’ve also strategically tried to plan trips when other vacation plans were cancelled for safety reasons, and constantly check my phone to see if I’m receiving emails or texts that align with my ideal future. What have I missed along the way?
 
There is so much compassion for this heart-mind that dearly loves mindfulness, not just for stress reduction, but for the deep and profound ways the teachings have changed and healed my life. Of course I am passionate about this! I just need to remember that is not the medicine for everyone. Or, the package it comes in, the way that it’s offered may not work for everyone.
 
As much as I enjoy and am committed to Western medicine for its miracles and healing opportunities, it does not always integrate body, mind and spirit the way meditation and writing do. I understand why it feels like a part of my healing energy, my creative spirit stagnates when it doesn’t flow the way I envisioned it would.
 
Life is asking me to be on the lookout for joy and wonder like a toddler delighting in summer bubbles and butterflies. Life is also asking me to get curious, to be patient, to delight in the care received from others and be on the lookout for opportunities to extend care to others. 
 
Having a distinct vision for joy, wonder, and care is not wrong. It’s the attachment for things to be a certain way that causes suffering. It’s the limiting beliefs that cause distress. Anything short or different from The Vision is a failure, not good enough, all my fault.
 
 
Letting Go (inspired by Tissa ~ Third)
 
Why stay here
in your little 
world?
 
If you really
want to be happy,
make 
every
moment,
a moment of care.
 
Open your mind.
Let go of limiting thoughts.
 
Then meet each moment
with curiosity and wonder.
 
 
May we all let go of life patterns that cause suffering. May we let go into life’s mysterious unfolding.
May we be on the lookout for joy, wonder and care in each moment.
 
(Please share information about this class with anyone interested. As I am learning to let go, I can still advertise😉!)

I’m surprised by the negative polarization against police officers after the death of George Floyd, and so many others. Don’t get me wrong. There are many overwhelming emotions moving though this heart-mind as they may be for you (anger bordering on rage, unspeakable fear, deep disappointment and hurt to name a few). Unnecessary violence masked in innocence, fueled by ignorance and implicit bias is never a good thing.

I can’t just point my finger at all the cases of police brutality. This may sound crazy, but the folks I find myself practicing Tonglen for first are police officers Derek Chauvin, J. Alexander Kueng, Thomas Lane, Tou Thao, and other officers, as well as George Floyd and others meeting death in savage, inhumane ways. How on earth did these officers think that what they were doing was OK, “equally” protecting the lives of all citizens? How are we as a society (you and I) contributing to macro and micro acts of violence on a smaller scale in the places we hold power?

I want to remember that not all police officers are like those who are getting the greatest publicity right now, that there are those who have deep respect and reverence for African American lives. And, this is also a wake-up call for more training and awareness, not just for the “guilty” officers, but for us all. As you are moved to demonstrate the yang of fierce compassion in whatever way you feel is right, please be a contemplative warrior for meaningful change looking at the 3 fingers pointing back at you when it’s so easy to place blame elsewhere.
​
Here is one way you might consider growing in awareness, making an intentional shift from racial innocence and distress to racial literacy and harmony within community.

The Dakini Speaks
© Jennifer Welwood

My friends, let’s grow up.
Let’s stop pretending we don’t know the deal here.
Or if we truly haven’t noticed, let’s wake up and notice.
Look: Everything that can be lost, will be lost.
It’s simple — how could we have missed it for so long?
Let’s grieve our losses fully, like ripe human beings,
But please, let’s not be so shocked by them.
Let’s not act so betrayed,
As though life had broken her secret promise to us.
Impermanence is life’s only promise to us,
And she keeps it with ruthless impeccability.
To a child she seems cruel, but she is only wild,
And her compassion exquisitely precise:
Brilliantly penetrating, luminous with truth,
She strips away the unreal to show us the real.
This is the true ride — let’s give ourselves to it!
Let’s stop making deals for a safe passage:
There isn’t one anyway, and the cost is too high.
We are not children anymore.
The true human adult gives everything for what cannot be lost.
Let’s dance the wild dance of no hope!
 

 
When I first heard this poem some years ago, it sounded bleak. Dance the wild dance of no hope? With a passion for beauty, creativity, singing, dancing, and music, I simply could not relate. I also couldn’t resolve the spiritual and creative parts of me that sometimes felt as odds with one another. Dhamma retreats that involved sitting, walking meditation, then more sitting and walking mediation for hours and days on end felt dry, as if something were missing. (Maybe this is why I insist on writing, sometimes singing and dancing on silent retreats when no one is looking or listening.)

Now, change and uncertainty have taken center stage. The Dakini speaks, and I am listening. Have I truly missed the deal here? I’m starting to wake up and notice. For me, uncertainty is so unsettling because of my patterns of control. Though I’ve told others this pandemic is not a sprint, but a marathon, I find myself at many imaginary finish lines hoping the race is over.

I want to travel, eat at my favorite restaurants, go on retreat, get together with family and friends, see patients in person, have my hair cut and colored, and not virtually! And I recognize these are minor inconveniences to have, as many others are suffering in real and devastating ways.

So how can I not act so shocked and grieve certain losses fully like a ripe human being? It helps to acknowledge these “losses” with honesty, without spiritually bypassing the true feelings of impatience, anger, sadness, fear, and overwhelm that may be present. The ripeness includes a clear, wise mind asking, “What’s happening now?” and a spacious, compassionate heart asking, “How am I relating to this?”

It’s important for me to remember that this practice is not perfect. Judgements and resistance still arise. All my habitual patterns of control (blaming others, blaming myself, food and retail therapy, meticulously cleaning, strategically planning) are implemented one after the other in the name of protecting the self. And so many things influence the fight-flight-freeze reaction and the tend and befriend response: physical, emotional, economic stability, practice history, etc.

Most days, I find that I am somewhere in between both physiologic processes. A quivering belly, rapid heart rate, and tense muscles are met with earth connection, warm breath, and fluid understanding of not acting so betrayed. Impermanence is life’s only promise, so what COVID-19 is teaching me is not new. I was just in denial.

Just as Toto pulled back the curtain to the great Wizard of Oz revealing an ordinary man, can I strip away the unreal and live with the real, giving myself completely to this one true ride? I’m tired of making deals for a safe passage. If there isn’t one, and the cost is too high, what does it mean to dance the wild dance of no hope? If there is no ground, what can I stand with, stand for?

I don’t have perfect, complete answers to these questions. Like many of you reading this, I’m still sensing my way into ‘answers’, trying to be as patient, honest, compassionate, and open as I can be along the way. Two words, concepts arising in meditation and life practice over the last few days are wholeness and goodness. Despite feeling broken, imperfect, and disconnected at times, I recognize that my purpose as a physician, meditation/movement practitioner, parent, and writer is not to cure everyone, but tap into an energy of healing that happens whenever the heart-mind is truly present and listening. And goodness isn’t a Pollyannish ignorance of the severe and overwhelming destruction caused by this pandemic, but stories of care I’m seeing, experiencing, and hearing about each day.

If impermanence is life’s only promise, then let my response be wholeness, goodness, and care, knowing that it is imperfect. What will your response be?
​
As you sit, stand, walk, and lie down with this ground of uncertainty, what is still true for you? The Buddha said, “Hatred does not cease by hatred, but only by love; this is the eternal rule.” May you connect with what is still true for you. May this guide you, support you, nourish you in the days and weeks to come.

(This post was inspired by Sebene Selassie, Sharon Salzberg, and Vesak.)

Find a sacred, quiet place where you can listen to this guided meditation. It's approximately 24 minutes long and set up in three parts. You can choose to pause at any point (will be clear when listening) or listen to the whole thing, trusting your body, mind, and heart to know what feels most nourishing.

Have a journal/paper, pen/pencil (or laptop), and art supplies nearby, in case you want to dive into the reflective journaling, artistic expression right after the meditation. You may also choose to wait, taking any necessary breaks between the meditation and writing/art.
​

Writing/Art Reflection

Writing Elements

-Timed writing.  Set a timer for a certain length of time (20-30minutes). Try and write for the full length of time.  Keep the pen moving on paper like a skater on ice.  This will encourage you to keep exploring, even when you feel stuck.  That being said, sometimes the kindest thing is to stop writing if you are feeling overwhelmed by something or feel as if your exploration is complete before time is up.  Writing continuously helps to bypass the left, logical, linear mind and the inner critic to access our creative, intuitive side.

-Nothing will be graded.  Let go of grammar, spelling, punctuation, etc.  Give yourself the permission and space to write in a manner that supports your exploration.  If it’s helpful, imagine you are having a conversation with a kind and supportive friend.  Feel free to say whatever you want to say.  You may even choose to write in your native language.

-If you get stuck, you can always write ideas down like a grocery list.  They don’t have to be complete sentences.  You can also rewrite part of the poem or writing reflection question that stands out to you and see where it takes you.
​
-Trust yourself.  If you’d like to write about something other than the writing prompt, feel free to do so.  This is your time to explore in a manner that will best serve you.

​
THE BIRDS OUTSIDE MY WINDOW SING DURING A PANDEMIC
 by Lee Herrick (deep bows of gratitude for permission to use this poem)
 
What we need has always been inside of us.
For some—a few poets or farmers, perhaps--
it’s always near the surface. Others, it’s buried.
It was in our original design, though—pre-machine,
pre-border, pre-pandemic. I imagine it like the light
one might feel through the body before dying,
a warm calm, a slow breath, a sweet rush.
There is, by every measure, reason for fear,
concern, a concert in the balcony of anxiety
made of what has also always been inside of us:
a kind of knowing that everything could break.
But it hasn’t quite yet and probably won’t.
What I mean to say is, I had a day dream
and got lost inside of it. There were dozens
of birds for some reason, who sounded like
they were singing in different accents:
shelter in place, shelter in place.
You’re made of stars and grace.
Stars and grace. Stars—and grace.

 
Writing Reflection:
​
Have you felt a sense of belonging near the surface or buried for you? Though it was in our original design, which do you identify with more? A concert in the balcony of anxiety, knowing that everything could break, or dozens of birds who sound like they are singing, Shelter in place, shelter in place. You’re made of stars and grace?
​
(Have you felt a sense of belonging or separation? Who/what has influenced this sense of belonging or separation?)
​
​

Art Reflection:
​
How does Greta Dietrich’s artwork inspire heart connection? How would heart connection, a sense of belonging look like for you?


Dyads: If you decide to share this experience with someone who has also taken the self retreat as above, set up a day/time when you can safely, virtually connect. Decide who will share first, while the other simply listens. (You can choose to set a timer for sharing 10 minutes each, or keep this more spontaneous. Each person should be given the same respect of time.) The one sharing can read what was written, share the process in his/her/their own words, or a combination of both. If you would like to share part or the mediation experience or art process, this is also welcome. The listener listens with his/her/their whole body, mind, and heart without the need to say or do anything else. After the speaker is done, the listener thanks the speaker for the vulnerability it took to share. Then roles are reversed. After both parties have the chance to share, the dyad may choose to move to an open dialogue about the process, or not.

May this offering be of service. I'd love to hear how it goes for you. Donations accepted to support the Southwest Indian Foundation (Navajo Nation).

​It’s not going to happen to me. It happens to older people, people with end stage cancer, daredevils who take risks. The tears I’ve been shedding these past few weeks are for other people who have died from COVID-19 complications, others who are affected socially, emotionally, economically, and physically by this pandemic. Not me.

A few days before my birthday, I started to feel pain in the chest wall. A slight tickle in the throat foreshadowed an ominous cough. But without shortness of breath and a fever, I wondered if this was anxiety or the beginnings of a diagnosis the whole world is keen to keep at bay. Were all those tears for others, or were some to help water seeds of understanding for this life?

With years of mindfulness practice and contemplations of impermanence, one would think I’ve considered the possibility of dying. I’m embarrassed to say that this heart-mind lives in a protective bubble of delusion. Even when my aunt, who was like a mother to me died from a poorly differentiated unnamed cancer six years ago, I still didn’t believe it could happen to me.

Till now. This virus has an eerie way threatening everything. A regular day at work in the outpatient setting with business casual clothing is now replaced with scrubs, tennis shoes, and sometimes full HAZMAT ensemble. A casual trip to the grocery store requires gloves, a mask, hand sanitizer, six feet between patrons, and timing to avoid long lines. Walks in the neighborhood on a sunny spring day feel strangely quiet, as if the outside air will kill on contact.  Zoom has become the virtual safe space where it’s all happening.

As physicians, we dance with illness and wellbeing on a regular basis. We even have end of life discussions with particular patients where prolonging life may sacrifice quality of life and personal wishes. But how often do we contemplate our own mortality?

What’s happening locally and globally is tenderizing this heart- mind like never before. There is a visceral (as opposed to cognitive) understanding that I will not live forever. This body may one day become immune to Covid- 19, but it cannot escape death as it’s natural end.

If you knew that your time on earth is limited, who or what would really matter? Would it be the white hairs showing through darker ones on video visits or zoom calls, or a heightened sense of touch from loved ones sheltering at home with you? Would you still answer “fine” to all the questions from colleagues, family and friends on how you are doing, or would you pause and follow the question to see where it leads?

I believe we have a responsibility to contemplate our own mortality, or at least begin to ask the hard questions. Our patients are facing the fear of sickness and death daily, hourly, every second, in every question asked and every look of a brewing storm just below the surface of feigned tranquility.

How do we find a middle way between anxious overwhelm and blatant denial? Perhaps it starts with opening to what is here, one slow breath, one small step at a time, not trying to predict an unknown future or take shelter in a past that no longer exists. When distracted by thoughts of wishing it were different or that you were elsewhere, the gentle invitation is to return to the present moment with as much kindness, and as little judgment as possible, to notice what’s happening inside your body and heart.  If the present moment is too triggering or overwhelming, it’s skillful to open in baby steps with lots of support.

The energy and effort required for this practice are not the same as striving for good grades, extracurricular activities, and letters of recommendation required for college, medical school, and residencies. You don’t get more points for overperforming. It takes a certain humility and courage to let go of labels, ideas, concepts to touch the bare truth.

Mark Nepo writes, “We waste so much energy trying to cover up who we are when beneath every attitude is the want to be loved, and beneath every anger is a wound to be healed and beneath every sadness is the fear that there will not be enough time.

When we hesitate in being direct, we unknowingly slip something on, some added layer of protection that keeps us from feeling the world, and often that thin covering is the beginning of a loneliness which, if not put down, diminishes our chances of joy.

It’s like wearing gloves every time we touch something, and then, forgetting we chose to put them on, we complain that nothing feels quite real. Our challenge each day is not to get dressed to face the world but to unglove ourselves so that the doorknob feels cold and the car handle feels wet and the kiss goodbye feels like the lips of another being, soft and unrepeatable.”
​
As we slowly unglove our hearts from all the protective armoring, may we skillfully connect with ourselves and each other, honoring the grief and gratitude arising along the way.

​​Whether you are caring for patients, clients, family, pets, others, the Earth, take some time in silence to recharge and connect with your deepest intentions for being alive. You are not an unlimited resource. Thank you for your care.

​